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Multidrug-resistant bacteria in organ transplantation: an emerging threat with limited therapeutic options
Gopi Patel1, Meenakshi M Rana, Shirish Huprikar
1Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY, 10029, USA, gopi.patel@mssm.edu.
Abstract:
Multidrug-resistant organisms (MDROs) are an emerging threat in solid organ transplantation (SOT). The changing epidemiology of these MDROs is reviewed along with the growing evidence regarding risk factors and outcomes associated with both colonization and infection in SOT. The management of these infections is complicated by the lack of antimicrobial agents available to treat these infections, and only a handful of new agents, especially for the treatment of MDR GNR infections, are being evaluated in clinical trials. Due to the increased prevalence of MDROs and limited treatment options, as well as organ shortages, transplant candidacy and use of organs from donors with evidence of MDRO colonization and/or infection remain controversial. Increasing collaboration between transplant programs, individual practitioners, infection control programs, and researchers in antimicrobial development will be needed to face this challenge.
Insights
Multidrug-resistant organisms pose a significant threat in solid organ transplantation. Addressing this requires better antimicrobial options and collaborative strategies to manage colonization and infection risks.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Microbiology
Background:
- Multidrug-resistant organisms (MDROs) present a growing challenge in solid organ transplantation (SOT).
- Epidemiological shifts, risk factors, and outcomes of MDRO colonization and infection in SOT patients are increasingly recognized.
- Limited availability of effective antimicrobial agents complicates the management of these infections.
Purpose of the Study:
- To review the changing epidemiology of MDROs in SOT.
- To examine risk factors and outcomes associated with MDRO colonization and infection in SOT.
- To discuss the challenges in managing MDRO infections and the implications for transplant candidacy.
Main Methods:
- Literature review of current research on MDROs in SOT.
- Analysis of epidemiological trends and risk factors.
- Evaluation of treatment strategies and antimicrobial development.
Main Results:
- MDRO prevalence is increasing in SOT recipients.
- Outcomes for SOT patients with MDRO colonization or infection are often poor.
- Few new antimicrobial agents are available, particularly for multidrug-resistant Gram-negative rods (MDR GNR).
Conclusions:
- MDROs represent a critical threat to SOT success.
- Transplant candidacy and organ utilization from donors with MDROs are complex issues.
- Enhanced collaboration among transplant teams, infection control, and researchers is essential to combat MDROs in SOT.
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